Non physician provider prescriptive privileges are determined by each state government and can vary widely in scope (Cipher, Hooker & Guerra 2006). The delegation of prescriptive authority for nurse practitioners as well as other allied health professional have been controversial thus acceptance has been slow (Cipher, Hooker & Guerra 2006). Prescriptive authority began to be delegated to nurse practitioners beginning in 1969 and grew to 40 states by 1993 with independent authority in 6 states (Cipher, Hooker, & Guerra 2006).
By 2005 nurse practitioners were able to prescribe in 13 states independently and have requirements in the others which range from direct physician supervision to delegated authority (Kaplan, Brown, Andrilla, & Hart 2006). Role in Public Health Current literature indicates that approximately 90% of patients seen by a primary care physician could be optimally managed by a nurse practitioner (Batey & Holland 1985). The most common barriers preventing nurse practitioners from completing the full primary care cycle are: laws, administrative rules, and organizational policy (Batey & Holland 1985).
The federal government is the largest employer of nurse practitioners is the federal government (Cipher, Hooker & Guerra 2006). The parts of the federal government where it is most common to see nurse practitioners work are: Department of Veteran Affairs, Bureau of Corrections, Public Health Clinics and many rural clinics (Cipher, Hooker & Guerra 2006). In many federal and rural settings nurse practitioners have similar prescriptive authority as physicians (Cipher, Hooker, & Guerra 2006).
State government have been slow to follow this example and nurse practitioners still must contend with medical and pharmacy boards to receive new or additional authority to prescribe medications (Kaplan, Brown, Andrilla, & Hart 2006). The obstacle that has prevented nurse practitioners from completing this cycle is the restrictions on prescriptive authority (Batey & Holland 1985). This has resulted from the perception of scant pharmacological training received by nursing in the past and the resistance of some to learn medication management concepts (Nolan 2004).
Nurse practitioner prescribing privileges has been a widely accepted practice in the improvement of healthcare delivery in the United States for the last 30 years (Nolan 2004). Advantages of Prescriptive Authority Nolan (2004) found that adding prescriptive authority to the daily practice of nurse practitioners added significantly to the scope of practice. Prescriptive authority for nurse practitioners provides benefits for professional development opening new career pathways (Nolan 2004).
The addition and expansion of prescriptive privileges for nurse practitioners increased public awareness to the existence of the profession (Nolan 2004). Ascertaining full autonomy has been an overriding goal of the nurse practitioner profession and obtaining full prescriptive authority is considered a leap in that direction (Kaplan, Brown, Andrilla & Hart 2006). Some states have developed legislation for a joint practice agreement which still required indirect physician involvement (Kaplan, Brown, Andrilla, & Hart 2006).